Allergic Mastocytic Gastroenteritis and Colitis: An Unexplained Etiology in Chronic Abdominal Pain and Gastrointestinal Dysmotility

A Akhavein M,N R Patel,S C Glover,P K Muniyappa

doi:10.1155/2012/950582

A Akhavein M, N R Patel + Show 2 more

Open Access

https://doi.org/10.1155/2012/950582

Copy DOI

Abstract

Abdominal pain, bloating, early satiety, and changes in bowel habits are common presenting symptoms in individuals with functional GI disorders. Emerging data suggests that these symptoms may be associated with mast cell excess and/or mast cell instability in the GI tract. The aim of this retrospective study was to evaluate the contribution of mast cells to the aforementioned symptoms in individuals with a history of atopic disease. A retrospective chart review of individuals seen in a university GI practice was conducted and twenty-four subjects were identified. The majority had abdominal pain, early satiety, and nocturnal awakening. 66.7% and 37.5% had a history of environmental and/or food allergy. Solid gastric emptying was increased as were the mean number of mast cells reported on biopsies from the stomach, small bowel, and colon (>37/hpf) by CD117 staining. Mean whole blood histamine levels were uniformly elevated. This study suggests that in individuals with these characteristics, consideration should be given to staining their gastrointestinal biopsies for mast cells as this may provide them with relatively non-toxic but highly targeted treatment options. Allergic gastroenteritis and colitis may represent a third type of GI mast cell disorder along with mast cell activation syndrome and mastocytic enterocolitis.

Highlights

Chronic abdominal pain together with symptoms of altered gastrointestinal motility defines a rather common presenting tableau in the gastroenterology practice, shared by idiopathic gastroparesis (IGP) and functional GI disorders such as irritable bowel syndrome (IBS) and functional dyspepsia (FD), among others.IBS is defined as a chronic continuous or remittent gastrointestinal illness characterized by frequent unexplained symptoms that include abdominal pain, bloating, and bowel disturbance, which may be either diarrhea or constipation or an erratic bowel habit that has features of both
Similar to FD and IGP, IBS presents with chronic abdominal pain and symptoms of GI dysmotility (GID)
This paper describes a distinct group of GI patients with chronic abdominal pain and symptoms of GI dysmotility, features that mimic the features of entities such as IBS, FD, or IGP, but who suffer from gastrointestinal mast cell excess and/or instability

Summary

Introduction

Chronic abdominal pain together with symptoms of altered gastrointestinal motility defines a rather common presenting tableau in the gastroenterology practice, shared by idiopathic gastroparesis (IGP) and functional GI disorders such as irritable bowel syndrome (IBS) and functional dyspepsia (FD), among others.IBS is defined as a chronic continuous or remittent gastrointestinal illness characterized by frequent unexplained symptoms that include abdominal pain, bloating, and bowel disturbance, which may be either diarrhea or constipation or an erratic bowel habit that has features of both. Increased numbers of GI mast cells have been documented in a subset of IBS patients throughout the small and large intestine [6]: in the duodenum [7], jejunum [8], ileum [9, 10], cecum [11, 12], ascending and descending colon, and rectum [10]. Mast cells and their mediators play a potential role in the pathophysiology of IBS by causing sensorimotor dysfunction of the gut through interactions with the enteric nervous system [13,14,15]. IBS has been increasingly linked to food allergy [16,17,18,19] in which mast cells play a critical role [20]

Methods

Results

Conclusion